Revenue Cycle Associate - Financial Clearance

Quorum Health Corporate•Brentwood, TN

2d•Remote

About The Position

The Revenue Cycle Associate, Financial Clearance position is responsible for ensuring that a patient’s visit is financially cleared prior to the date of service. The role includes verifying patient insurance eligibility/benefits, calculating patient liability estimates, securing prior authorization, providing notice of admission, obtaining referrals, and verifying medical necessity. These efforts will result in increased net revenues by reducing front-end related denial write-offs. Interactions will be conducted with providers, payers, patients, and hospital-based personnel. Duties are to be performed accurately and timely while providing exceptional customer service.

Requirements

Proficient in typing.
General knowledge of medical terminology.
Ability to communicate effectively and professionally in English, both verbally and in writing.
Critical thinking and problem-solving skills.
High school graduate or equivalent.

Nice To Haves

One year of related experience in the medical field is preferred.

Responsibilities

Ensures Financial Clearance (e.g., verification of eligibility/ benefits, securing prior authorization, etc.) is obtained timely prior to the patient’s date of service based on service line and departmental policies.
Performs coverage discovery using eligibility tools to identify additional insurance coverage if existing insurance on file is inactive.
Calculates and clearly documents patient liability estimates based on patient’s verified benefit information.
Provides payers with timely inpatient and observation Notices of Admission (NOA) as required based on payer-specific guidelines.
Validates prior authorization has been obtained and follows up with providers via phone as required for applicable services lines.
Verifies medical necessity for applicable patients and identifies instances where a Medicare Advance Beneficiary Notices of Noncoverage (ABN or NONC) is required.
Escalates instances where Financial Clearance may not be obtained (e.g., unable to obtain authorization) prior to patient’s DOS to appropriate stakeholders in accordance with departmental deferral policies.
Resolves insurance coverage and authorization information discrepancies as identified through automated quality assurance tool.
Works denials related to referral, authorizations, notifications, non-coverage, and medical necessity as assigned. This includes, but is not limited to, coordinating with appropriate stakeholders to submit rebills or appeals and obtaining retro authorization when required.
Observes privacy, safety, and security procedures, and uses equipment and materials properly.
Possesses the ability to work within a remote call center environment, free from distractions and background noise.
Recognizes and consistently exhibits exceptional customer service as a critical factor in all duties performed.